F&M College Plus Loan Refund Release Form

Student Information

Name:________________________________

F&M ID Number:______________________

Parent (Borrower) Information

Name:________________________________

Address:______________________________

City:_________________________________

State/Zip:_____________________________

E-Mail:______________________________

Telephone:___________________________

______________ Refund to the Student

______________ Refund to the Parent (Borrower) at above address

_______________________________  _______________

Borrower's Signature                         Date